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Medicines for Heart Failure - Topic Overview


Because there is very good evidence that ACE inhibitors, ARBs, beta-blockers, and spironolactone can prolong survival in people with heart failure, your doctor will aim to have you take these medicines, if appropriate.

Also, several other classes of medicines can be helpful in relieving symptoms of people with heart failure. There is less clear evidence that these medicines prolong survival, so your doctor will usually use these second-line medicines only if you are already taking each of the main classes of medicines or if you cannot tolerate one or more of the main medicines.

Second-line medicines for heart failure

Drug class

How it works


VasodilatorsThese drugs relax the smooth muscle in your arteries and therefore lower the amount of blood pressure the heart has to beat against. Nitrates also dilate the veins, alleviating some of the congestion from blood backed up behind the heart.
  • Hydralazine
  • Organic nitrates
  • Alpha-blockers
Calcium channel blockers These drugs are vasodilators. They may be particularly useful in diastolic heart failure. But they may make systolic heart failure worse. They slow the heart rate and decrease the force of the contraction of the heart, which may prevent further damage to the heart.
  • Verapamil
  • Diltiazem
DigoxinDigoxin increases the force of contraction of the heart.
  • Digoxin
Warfarin (Coumadin)Warfarin thins blood and prevents blood clots.
  • Warfarin

What types of medicines are used in the hospital?

If you go to the hospital because of sudden heart failure, also called a flare-up, your doctor will first try to stabilize your condition. The doctor will immediately prescribe drugs such as diuretics, nitrates, and/or morphine to help you breathe more easily and to control your pain or anxiety. These drugs should quickly relieve your symptoms.

Your doctor may also order an oxygen mask that fits over your nose and mouth. The oxygen helps make sure that your heart and the rest of your body are receiving plenty of oxygen. After your condition is stabilized, your doctor will try to find out what caused your flare-up and whether your heart has been damaged.

First treatments of a sudden heart failure flare-up


What does it do?

Diuretic Removes extra salts and fluid from your body
NitrateDilates blood vessels and decreases fluid buildup in the lungs
MorphineReduces pain and anxiety
OxygenIncreases oxygen levels in your blood

If these medicines do not help you enough, your doctor might try more aggressive medicines such as nesiritide (Natrecor) which helps relax certain blood vessels and gets rid of extra sodium and water from the body. Nesiritide is only used after trying other treatments. Your doctor will watch you closely for problems, because nesiritide can cause serious kidney problems, irregular heartbeats, and low blood pressure.


WebMD Medical Reference from Healthwise

Last Updated: August 09, 2010
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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